Provider Demographics
NPI:1902117997
Name:REZENDES, LAUREN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:REZENDES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 FURNACE BROOK PKWY
Mailing Address - Street 2:SUITE 31
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1261 FURNACE BROOK PKWY
Practice Address - Street 2:SUITE 31
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4721
Practice Address - Country:US
Practice Address - Phone:617-479-4545
Practice Address - Fax:617-479-4521
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4119363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant